DavidKarl

What a psychotic way to staff a place- begging for med errors, and the like. Unless most of the staff is agency? If that's the case, they are trying to spread their in house staff around, to DECREASE liablity, so their own staff sees the patients at least some of the time?

Don't forget the LTC folks that are sent out to be admitted (for 3 days, naturally) for an easily treatable UTI, or etc., in order to requalify for MED-A.

An easy way to affect a transfer to a different SNF, once admitted? Just raise. HELL. The first place will pull out all of the stops to help you out.

No time to urinate? Hmm. A SNF nurse that never heard of Depends? This alarms me.

Lot's of RNs look down their noses at LPNs, but usually they are new grad RNs that are intimidated by the practical skills LPNs might posses. This stuff happens in any occupation. Other than that-here's a related cute one, that's happened to me 100's of times: "Hi, I'm David- I'm going to be your nurse for this shift". Silence. Then?:"Oh, so you're a MALE nurse?". "Yes- and I'm REAL glad you noticed!"

I was fired once when I failed to quit- the DON made a new boyfriend, who was also an LPN (and wanted my job), and made all type of excuse that I was incompetent. I took my glowing evaluations, etc. to unemployment, to get an official determination that I was fired without cause- but that determination and $1.50 will get you a cup of coffee. Clear your mind, and move on. It's the new lay of the land: disposable employees. Even if you love your current job? It never hurts to read the want ads every Sunday. I'm just sayin'.

The real issue is that word: assessment. In some states an LPN cannot legally 'assess' a patient, but 'evaluates', or etc. It's weird but true. Wicki describes an assessment as a 'plan of care'- lots of states don't allow that scope in LPN practice, and some even require a BSN, rather than an ADN, to be qualified to 'care plan' a patient. When I was in FL, an RN had to co-sign certain forms and notes completed by LPNs. Print your nurse practice act and keep it in your locker at work. It's basically the rules, in your BON's language, that allow you to keep your license. Be especially careful about IVs, if you have an IV cert in your state as an LPN. The language, although cumbersome, is very specific in the practice act.

Another thought- who ordered the IV med, and who started the IV, and who started the IV med via the IV? Two, possibly 3 healthcare workers involved (aside from the LPN) were treating a patient with an IV, without possibly obtaining consent, but obviously without bothering to tell the patient what was going on, and why the IV was needed. And, also- why didn't the patient ASK the ordering provider, or the nurse while the IV was going in, or what the medication was when it was hanged, since she appears to be alert, etc., and taking notes? Lots of potential liability in this scenario- especially if the RN made a med error that wasn't caught by the LPN, eh? I've seen an awful lot of nonchalance, and lawsuits about IVs.

I suspect that the atomosphere in that place is that the RN makes it clear that she is there to supervise, and not do any hands-on care. I suspect that's what the LPN meant to imply, but it was inaccurately told to the EMTs. I also agree that some EMTs have a holier than thou attitude- last place I worked, I'd just lay the transfer paperwork on the desk for them to pick up, because they were above me (just an LPN) to bother even asking why the call was made, or my obervations. As I say this- most folks have no idea that EMTs are paid a little above minumum wage? So, even they are first responders and can possibly save your life- they are not paid a liveable wage. Knowing the nurses that call them make several times what they do, I keep that in mind.

There are 40, maybe 70 million uninsured in America. Another 100 million can't afford to USE their insurance, due to the high deductibles. The uninsured use ERs, and don't pay. Under Obamacare, 20 or maybe 50 million people will now be able to obtain insurance. How can adding millions of newly insured patients, indicate a monetary loss for hospitals? It can't, and doesn't. Hospitals are using it as a technique to save money (rather, see the end of this sentence), scare employees, and etc...but at the same time they are all spending billions on new construction (to be prepared for the huge influz of, paying patients)? For those of unaware of Obamacare, Wickipedia has an in-depth detail of the consequences, and benefits- the best I've seen, to try to make sense of the chaos that will happen in 2014. But there are going to be a LOT of winners, and losers..it all depends on your income, and whether your employer will retain you as full time and be required to provide you a plan. The biggest losers will be individual plan owners with significant incomes- your premiums will 'explode', and also employees that are cut below full time, and forced into the individual plan system. The biggest winner? HOSPITALS, since almost everyone will now have insurance to pay THEM.

My second clarification- I was talking licensed staff only. Obviously, CNAs are taken for granted, abused, unappreciated, paid slave wages, and many have personal strife to deal with. I have always advocated them, and usually taken their sides in arguments, nurse vs aide bickering, and have never allowed a nurse to treat any CNA badly, if I was aware of it. I tried that gig way back in the 1980's, when everyone was tied down, and it took an hour to change those cloth diapers, and all the patients were drugged and immobilized. At least now there are disposables, few restraints, patients are more mobile and helpful, and etc. But, it's still 'the most difficult job in a SNF', if not in the WORLD. I've always thought up ways to ease their job, help them be organized to prevent repeating steps, stay calm, and the like. They love it when I'm working their assignment, they think I'm from another planet because I answer lights, toilet folks, feed them, help them change folks, insist that they take their breaks, and the like.

Is this 'palliative' care more aptly what would be 'hospice' care, if the patients qualified for Medicare or another program that paid for hospice, but don't, so therefore are on Medicaid, or etc? If yes, I can imagine the nightmare caseload you have, since every state is broke. Wonder what'll happen next year with Obamacare, in your line of work?

(Oops, correction to the above: choking RISK).

If you don't care plan that the patient has dentures, those reading the care plan (as if...anyone does, other than surveyors?) wouldn't know that he had dentures, for example, and if he could not speak, he may be taken to meals without his dentures, which would be a choking . We've all happened upon dentures, also, that had been sitting untouched/unwashed in a cup for a few days, or months. Not pretty.

There is no 'care plan meeting' requirement. The requirement is that the patient/and or family must be able to 'be involved in the care plan process'. No meeting, again, is required. Why does everyone go through this ordeal, that, even most family members despise? I don't have the answer.